Online Service REQUEST

If you have a service request or simply just a question, please contact ECC by filling out the form below and submitting it to us. An investigator will contact you within 24 hours by the method you choose from below. We will NOT call you unless you specify that we may call you and times that are allowed.

SERVICE REQUEST FORM
Company
Name *
E-mail *
Telephone *
Address
City
State
Contact Method *
Contact Time *
Investigation Requested
Your Message
FOR INSURANCE RELATED CASES ONLY
Requestor
Insured
Date Requested
Date Due
Case/Claim #
Authorized Hours/Budget
CLAIMANT/SUBJECT INFO
Name
Address
Telephone
Injury
Date of Incident
Sex
Date of Birth
SSN
Height/Weight
Race
Distinguishing Marks
Attorney Info
Service Requested
Additional Info
Upload Forms or Pictures

Please note: Submitting this form does not constitute a contract or agreement with East Coast Confidential, LLC. Once your information is received, we will review your case and contact you by the method you have chosen above to discuss your options. All information supplied is kept strictly confidential.

East Coast Confidential, LLC 32 Pickwick Center, Colonial Heights, VA 23834
Phone: 804-869-2000 | Toll: 877-229-7935 | Fax: 804-520-4355

Department of Criminal Justice Services #11-5879 and #88-1038

ECC 2012